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Individualized Isonatremic and Hyponatremic Dialysate Improves blood pressure in Patients with Intradialytic Hypertension: A Prospective Cross-Over Study with 24-h ambulatory blood pressure monitoring

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Open Journal of Nephrology 2020年第2期10卷 144-157页

作者： Tom Robberechts Mandelina Allamani Xavier Galloo Karl Martin Wissing Patricia Van Der Niepen Department of Nephrology and Hypertension Universitair Ziekenhuis Brussel VUB Brussels Belgium

Background. Intradialytic hypertension, a paradoxical rise in systolic blood pressure from pre- to postdialysis, is a poorly understood and difficult-to-treat phenomenon. We examined the effects of individually adjusted isonatremic and hyponatremic dialysate on intradialytic and interdialytic blood pressure in patients with intradialytic hypertension. Methods. We enrolled 11 patients with intradialytic hypertension in a prospective randomized cross-over study, with 4 treatment periods of different dialysate sodium concentrations. Period 1 (run-in) and 3 (wash-out) were standardized at 140 mEq/L;period 2 and 4 with iso- or hyponatremic sodium dialysate. blood pressure was recorded each dialysis session, and 24-hour ambulatory blood pressure monitoring was performed at the end of each treatment period. Results. Isonatremic and hyponatremic dialysate were associated with significantly lower pre- and post-dialysis blood pressure as compared to baseline 140 mEq/L dialysate (predialysis 148.3 ± 24.7/67.7 ± 12.0 and 144.4 ± 16.5/68.8 ± 13.3 vs. 158.0 ± 18.3/75.6 ± 11.4 mmHg, resp p = 0.04 and 0.007 for systolic and p = 0.004 and 0.04 for diastolic blood pressure;postdialysis 154.2 ± 25.5/76.6 ± 14.1 and 142.5 ± 20.7/73.0 ± 12.9 vs. 159.1 ± 21.6/80.3 ± 12.1 mmHg, resp NS and p = 0.01 for systolic and NS and p = 0.04 for diastolic blood pressure). Postdialysis and 24 h systolic blood pressure tended to be lower with hyponatremic compared to isonatremic dialysate. Conclusion. Individually tailoring dialysate sodium concentration, based on the sodium set-point of each patient, resulted in a lower pre- and post-dialysis blood pressure in patients with intradialytic hypertension. 24 h blood pressure values tended to be lower as well with hyponatremic dialysate.

关键词： Intradialytic Hypertension ambulatory blood pressure monitoring Dialysate Sodium Concentration

ambulatory blood-pressure monitoring, antihypertensive therapy and the risk of fall injuries in elderly hypertensive patients

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Journal of Geriatric Cardiology 2018年第4期15卷 284-289页

作者： Michael Jonas Rasisa Kazarski Gil Chemin Department of Cardiology Kaplan Medical Center Hebrew University School of Medicine Rehovot Israel Department of Nephrology and Hypertension Kaplan Medical Center Hebrew University School of Medicine Rehovot Israel

Background Fall injuries are common among the elderly. The aim of this study was to investigate whether blood-pressure patterns, as measured by 24-h ambulatory blood pressure monitoring （ABPM）, or intensification of antihypertensive therapy following the 24-h ABPM, may be associated with fall injuries in hypertensive elderly patients. Methods In a retrospective study, community-based elderly patients （age ≥ 70 years） who were referred to 24-h ABPM were evaluated for fall injuries within one-year post-ABPM. We compared the clinical characteristics, 24-h ABPM patterns and the intensification of hypertensive therapy following 24-h ABPM, between patients with and without a fall injury. Results Overall 1032 hypertensive elderly patients were evaluated. Fifty-five （5.3%） had a fall injury episode in the year following ABPM. Patients with a fall injury were significantly older, and with higher rates of previous falls. Lower 24-h diastolic blood-pressure （67.3 ± 7.6 vs. 70.7 ± 8.8 mmHg; P 〈 0.005） and increased pulse-pressure （74.7 ± 14.3 vs. 68.3 ± 13.7 mmHg; P 〈 0.005）, were found in the patients with a fall injury, compared to those without a fall injury. After adjustment for age, gender, diabetes mellitus and previous falls, lower diastolic blood-pressure and increased pulse-pressure were independent predictors of fall injury. Intensification of antihypertensive treatment following the 24-h ABPM was not associated with an increased rate of fall injury. Conclusions Low diastolic blood-pressure and increased pulse-pressure in 24-h ABPM were associated with an increased risk of fall injury in elderly hypertensive patients. Intensification of antihypertensive treatment following 24-h ABPM was not associated with an increased risk of fall injury.

关键词： ambulatory blood pressure monitoring Hypertension Falls

Uncontrolled hypertension in older patients： markers and associated factors to masked and white-coat effect

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Journal of Geriatric Cardiology 2016年第8期13卷 672-678页

作者： Nereida KC Lima Julio C Moriguti Eduardo Feniolli Division of General lnternal Medicine & Geriatrics Internal Medicine Department Ribeirao Preto Medical School Sao Paulo University Sao Paulo Brazil

Background Hypertension is the main risk factor for cardiovascular diseases, affecting more than half the elderly population. It is essential to know if they have proper control of hypertension. The aim of this study was to identify the associated factors to masked uncon- trolled hypertension and false uncontrolled hypertension in older patients. Methods Two-hundred seventy-three individuals （70.1±6.7 years-old） had blood pressure （BP） measured at the office and by ambulatory BP monitoring （ABPM）, with the definition of controlled group （C）, individuals with high office BP and adequate ABPM, called white-coat effect group （WCE）, uncontrolled （UC）, and subjects with ap- propriate office BP and elevated ABPM denominated masked effect group （ME）. Age, body mass index, diabetes, pulse pressure （PP） and BP dipping during sleep were evaluated （Kruskal-Wallis test and logistic regression models）. Results Age was higher in UC than in C and ME （P 〈 0.01）, and 24-h ABPM PP was lower in C （48± 7 mmHg） and WCE （51±6 mmHg） than in UC （67±12 mmHg） and ME （59±8 mmHg）（P 〈 0.01）. Sleep systolic BP dipping was lower in ME than in C （P = 0.03）. Female gender was associated with a greater chance of being of ME group, which showed a higher PP and lower BP dipping during sleep. Conclusions In older individuals, office BP measure- ments did not allow the detection of associated factors that would permit to differentiate WCE from UC group and C from ME group. ABPM favored the identification of a higher PP and a lower BP dipping during sleep in the masked effect and uncontrolled groups.

关键词： ambulatory blood pressure monitoring Hypertension Masked effect The aged White coat effect

Neurogenic orthostatic hypotension with Parkinson's disease as a cause of syncope:A case report

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World Journal of Clinical Cases 2021年第21期9卷 6073-6080页

作者： Ya Li Min Wang Xiang-Lan Liu Ya-Fei Ren Wen-Bin Zhang Department of Cardiovascular Diseases Sir Run Run Shaw HospitalCollege of Medicine of Zhejiang UniversityHangzhou 310016Zhejiang ProvinceChina Department of Rehabilitation Medicine Qilu Institute of TechnologyJinan 250200Shandong ProvinceChina

BACKGROUND Syncope presents with diagnostic challenges and is associated with high healthcare *** orthostatic hypotension(nOH)as one cause of syncope is not well *** review a case of syncope caused by nOH in a patient with Parkinson's *** SUMMARY We describe a case of syncope caused by nOH in Parkinson's disease and review the literature.A 70-year-old man with Parkinson's disease had uncontrolled blood pressure for 1 mo,with blood pressure ranging from 70/40 to 220/112 mmHg,and once lost consciousness lasting for several minutes after getting *** blood pressure monitoring indicated nocturnal hypertension(up to 217/110 mmHg)and morning orthostatic hypotension(as low as 73/45 mmHg).Seated-to-standing blood pressure measurement showed that the blood pressure dropped from 173/96 mmHg to 95/68 mmHg after standing for 3 min from supine position.A diagnosis of nOH with supine hypertension was *** the course of treatment,Midodrine could not improve the ***,the patient's blood pressure stabilized with simple strategies by strengthening exercises,reducing the duration of lying in bed in the daytime,and consuming water intake before getting *** nOH is one of the causes of *** blood pressure monitoring is a cost-effective method for its diagnosis,and non-pharmacological measures are still the primary management methods.

关键词： Neurogenic orthostatic hypotension Syncope Supine hypertension ambulatory blood pressure monitoring Non-pharmacological management Case report

Effects of Chinese herbal medicine Yiqi Huaju Formula on hypertensive patients with metabolic syndrome:a randomized,placebo-controlled trial

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Journal of Integrative Medicine 2013年第3期11卷 184-194页

作者： Yi Chen De-yu Fu Yu Chen Yan-ming He Xiao-dong Fu Yan-qiu Xu Yi Liu Xiao-tao Feng Teng Zhang Wen-jian Wang Institute of Integrative Medicine Huashan HospitalFudan University Yueyang Hospital of Integrated Traditional Chinese and western Medicine Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Clinical Research Institute of Integrative Medicine Shanghai University of Traditional Chinese Medicine

BACKGROUND： Patients with hypertension coupled with metabolic syndrome （MetS） are among the high risk population in cardiovascular and cerebrovascular diseases. To reduce the prevalence of cardiovascular and cerebrovascular diseases, it is essential to appropriately control b^ood pressure together with other cardiovascular risk factors. OBJECTIVE： The current study was designed to investigate the therapeutic effects on blood pressure, blood pressure variability and other cardiovascular risk factors by giving Yiqi Huaju Formula, a compound traditional Chinese herbal medicine, in addition to routine treatment to hypertensive patients coupled with MetS. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： A total of 43 patients with hypertension coupled with MetS were recruited into this study. The enrolled patients were randomly divided into the Chinese herbal formula group （anti-hypertensive drugs plus Yiqi Huaju Formula, CHF） and the control group （anti-hypertensive drugs plus placebo）. The CHF group enrolled 22 patients while the control group received 21 cases. Treatments were given for 12 weeks in both groups. MAIN OUTCOME MEASURES： Parameters examined include 24-hour ambulatory blood pressure monitoring, body mass index, waist circumference, waist-to-hip ratio, homeostatic model assessment for insulin resistance （HOMA-IR）, fasting glycosylated hemoglobin （HbAlc）, fasting plasma glucose, 2-hour postprandial plasma glucose （PPG）, fasting plasma insulin, serum lipid, etc. RESULTS： Compared with the control group, the CHF group had significant improvement （P〈0.01） in anthropometric parameters, FPG, HOMA-IR, blood pressure amplitude, blood pressure variability and blood pressure load. CONCLUSION： This study showed that integrated traditional Chinese and Western medicine treatment can achieve better results in controlling blood pressure as well as other cardiovascular risk factors. The mechanism of controlling of blood pressure may be associated with the improvement of in

关键词： metabolic syndrome hypertension ambulatory blood pressure monitoring blood pressure variability drugs, Chinese herbal therapies, investigational

The Relationship between Abnormal Circadian blood pressure Rhythm and Risk of Readmission in Patients with Heart Failure with Preserved Ejection Fraction

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Cardiovascular Innovations and Applications 2021年第2期5卷 275-282页

作者： Diqing Wang Zhengfei He Sihua Chen Jianlin Du Department of Cardiology the First People’s Hospital of Fuyang District in HangzhouHangzhou311400China Department of Cardiology the Second Affi liated Hospital of Chongqing Medical UniversityChongqing400010China

Objective:Abnormal circadian blood pressure rhythm has been revealed to be associated with hypertensive target organ damage and cardiovascular events,but its association with readmission risk in patients with heart failure with preserved ejection fraction(HFpEF)remains *** conducted a retrospective study to explore the relationship between circadian blood pressure rhythm and readmission risk in HFpEF ***:We retrospectively collected baseline and follow-up data on HFpEF patients who underwent ambulatory blood pressure monitoring(ABPM)from May 2015 to October *** circadian blood pressure rhythms defi ned by ABPM were grouped as dipper,nondipper,or riser *** and multivariate linear regression analyses were performed to assess the association between circadian blood pressure rhythm and readmission ***:A total of 122 patients were enrolled in this *** mean age and ejection fraction were 69.87 years and 61.44%,respectively,with mean the N-terminal pro-B-type natriuretic peptide(NT-proBNP)level being 1048.15 pg/*** were signifi cant differences in the 24-hour systolic blood pressure(SBP),sleep SBP,and sleep diastolic blood pressure(DBP)among the three groups,where the 24-hour SBP,sleep SBP,and sleep DBP in the riser pattern group were markedly higher than in the dipper pattern ***,serum NT-proBNP levels,the proportion of patients readmitted for heart failure and the mean number of admissions differed markedly among three ***,multivariate linear regression analysis showed that the riser pattern was a signifi cant and independent risk factor for increased serum NT-proBNP level(β=929.16,95%confi dence interval 178.79–1679.53,P=0.016).In multivariate logistic regression analysis,the riser pattern was demonstrated to be a signifi cant risk factor for readmission(odds ratio 11.23,95%confi dence interval 2.01–62.67,P=0.006)in HFpEF ***:The riser blood pressure pattern is a

关键词： Heart failure with preserved ejection fraction circadian blood pressure rhythm ambulatory blood pressure monitoring riser pattern N-terminal pro-B-type natriuretic peptide readmission

Predictive Value of blood pressure,Heart Rate,and blood pressure/Heart Rate Ratio in a Chinese Subpopulation with Vasovagal Syncope

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Cardiovascular Innovations and Applications 2021年第1期5卷 193-205页

作者： Zhuzhi Wen Jingying Hou Zun Mai Huifen Huang Yangxin Chen Dengfeng Geng Jingfeng Wang Department of Cardiology Sun Yat-sen Memorial Hospital of Sun Yat-sen UniversityGuangzhouChina Guandong Province Key Laboratory of Arrhythmia and Electrophysiology GuangzhouChina Emergency Medicine Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouChina Breast Tumor Center Sun Yat-Sen Memorial HospitalSun Yat-Sen UniversityGuangzhouChina

Objective:The head-up tilt test(HUTT)is widely used but is time-consuming and not cost-effective to evaluate patients with vasovagal syncope(VVS).The present study aims to verify the hypothesis that ambulatory blood pressure(BP)monitoring(ABPM)and the simplistic tilt test may be potential alternatives to the ***:The study consecutively enrolled 360 patients who underwent the HUTT to evaluate ***),heart rate(HR),and BP/HR ratios derived from ABPM and the simplistic tilt test were evaluated to predict the presence,pattern,and stage of syncope during the ***:Mixed response was the commonest pattern,and syncope occurred frequently with infusion of isoproterenol at a rate of 3μg/*** the simplistic tilt test,the cardioinhibitory group had higher tilted BP/HR ratios than the vasodepressor group,while the vasodepressor group had a faster tilted HR and a larger HR difference than the cardioinhibitory *** higher the BP/HR ratio in the tilted position,the higher the isoproterenol dosage needed to induce a positive *** ABPM,BP/HR ratios were signifi cantly higher in the cardioinhibitory group than in the vasodepressor *** higher the ABPM-derived BP,the higher the dosage of isoproterenol needed to induce *** were signifi cant correlations in BP/HR ratios between ABPM and the supine position in the vasodepressor group,while signifi cant correlation was found only for the diastolic BP/HR ratio between ABPM and the tilted position in the cardioinhibitory *** mixed pattern shared correlative features of the other two ***:ABPM and the simplistic tilt test might be used as promising alternatives to the HUTT in VVS evaluation in clinical settings.

关键词： Vasovagal syncope head-up tilt test simplistic tilt test ambulatory blood pressure monitoring blood pressure/heart rate ratio

Association of blood pressure variability with target organ damage in older patients with essential hypertension

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Chronic Diseases and Translational Medicine 2023年第4期9卷 320-328页

作者： Zhiquan Jing Gang Wang Zeya Li Shanshan Wu Xiang Qiu Rongchong Huang Department of Cardiology Beijing Friendship HospitalCapital Medical UniversityBeijingChina Department of Clinical Epidemiology and EBM Beijing Friendship HospitalCapital Medical UniversityBeijingChina Department of Cardiology Beijing Fangshan First HospitalBeijingChina

Background:Although multiple measures of blood pressure variability(BPV)have been proposed,whether they are better than mean blood pressure in predicting target organs is *** aimed to determine the relationship between short term BPV and target organ ***:This study was a retrospective study,and 635 inpatients in the Department of Cardiology from 2015 to 2020 were *** divided participants into four groups on the basis of the quartiles of ***-way analysis of variance was used to compare the differences between the groups,and linear regression was used to analyze the relationship between BPV and target organ ***:The average age of 635 patients was 74.36±6.50 years *** them,354 of 627 patients had diminished renal function(56.5%),221of 604 patients had associated left ventricular hypertrophy(36.6%),and 227 of 231 patients had carotid plaque formation(98.3%).The baseline data indicated significant differences in fasting glucose,total cholesterol,low-density lipoprotein,creatinine,glomerular filtration rate,sex,calcium channel blocker use,and the rate of diminished renal *** linear regression analysis showed that BPV was negatively correlated with renal injury(creatinine:r=0.306,p<0.01;estimated glomerular filtration rate:r=0.058,p<0.01),and BPV is positively correlated with cardiac injury(r=0.083,p<0.01).Elevated BPV was not found to be associated with ***:Renal function decreases with increasing BPV and left ventricular mass increases with increasing BPV.

关键词： ambulatory blood pressure monitoring blood pressure variability hypertension target organ damage

Association of circadian blood pressure pattern and left heart chamber enlargement in hypertensive patients:A cross-sectional study

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South China Journal of Cardiology 2020年第4期21卷 227-234页

作者： ZHONG Qi CAI An-ping LIU Chao-fan ZHOU Dan LI Xi-da FENG Ying-qing ZHOU Ying-ling Department of Cardiology Guangdong Cardiovascular InstituteGuangdong Provincial Key Laboratory of Coronary DiseaseGuangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhou 510080China

Background Non-dipping blood pressure(BP)pattern is a potential risk factor contributing to cardiac geometry *** between BP pattern and left atrium(LA)enlargement besides left ventricle(LV)structural change is seldom *** A total of 237 hypertensive and hospitalized adults were *** heart chamber parameters were measured by 2-dimensional echocardiography,and BP circadian rhythm was evaluated by 24-hour ambulatory blood pressure ***-day ratios of systolic BP(NDR-SBP)were calculated and BP patterns were classified into dippers,reduced-dippers,and risers,which were defined as NDR-SBPblood lipid profiles,mean diurnal BP and estimated glomerular filtration rate,the association between increased LV diameter and riser BP pattern was significant(OR:2.621,95%CI:1.030-6.678)while the association between increased LA diameter and riser BP pattern was marginally *** The riser BP pattern is associated with the enlargement of LV and probably that of LA in hypertensive patients independent of 24-hour systolic BP level.

关键词： ambulatory blood pressure monitoring ventricular remodeling hypertension circadian rhythm